Appendix 1

Reimbursement Requirements for Medicaid Programs and Private Payers Vary Widely State to State
Medicaid reimburses for the following telemedicine services…
(Restrictions on services, conditions, providers and sites apply)
Private payers reimburse
(Restrictions apply)
  Live Video? Store and Forward? At-home Remote Patient Monitoring? Email Phone Fax? Home as originating site? For some telemedicine services? Telehealth at same rate as in-person care?
AL X Only for DM & CHF X X X X
AK X X X X
AZ Includes OBGYN, excludes abortion Excludes OBGYN & primary care For CHF X X Excludes abortion X
AR Excludes abortion X X X X Excludes abortion
CA X Some *
CO Dental X
CT Behavioral health only Provider to provider only X Some X X
DE X X X
DC X Xb X X X
FL Behavioral health only X X X X X
GA Ultrasound, X-ray, dentistry only X X X * *
HI X a X b X g
ID Includes primary care X X X X X X
IL X Uterine monitoring and BP in pregnancy X X X
IN Excludes abortion X X X Excludes abortion X
IA Excludes abortion X X c Some X Excludes abortion X
KS Excludes abortion X X X Excludes abortion Xd
KY Radiology only X X
LA X X X X
ME X Some X Xd
MD X X
MA Behavioral health only X X X X X
MI X X X X
MN X
MS Radiology only a X X X
MO X Includes pregnancy X X X
MT X X X X
NE Radiology only X X X
NV X X X
NH Xa,e Xe X X
NJ Behavioral health only X a Xb X
NM X X X
NY X X
NC X X X X X X
ND X X X X Xd
OH X X X Xf
OK X X X X X
OR Dental Some X X
PA X X X X X X
RI X X X X X
SC X X X X
SD X X X X X
TN Crisis-related only X X X X
TX Excludes abortion Only w/ real-time audio Includes pregnancy X Excludes abortion X
UT X X X X
VT X For CHF X X
VA Includes OB ultrasound Excludes OBGYN & primary care Includes DM in pregnancy X X X
WA Behavioral health & dentistry Excludes OBGYN & primary care X X
WV X X X X X X
WI X X X X X X
WY X X X X X
Total states 50 + DC 14 22 5 19 41 + DC 10
NOTES: Telemedicine services must typically be shown to be equivalent to in-person services to meet reimbursement requirements.
CHF= Congestive heart failure
*Law exists but not currently in effect.|
a HI, MS, NH, NJ have laws requiring reimbursement for store and forward in Medicaid, however are not in effect or do not have corresponding policy indicating enforcement.
b DC, HI, NJ have laws requiring reimbursement for remote patient monitoring in Medicaid, however are not in effect or do not have corresponding policy indicating enforcement.
c Iowa supposed to start remote patient monitoring program in July 2019 for Medicaid Managed Care plans.
d Reimbursement has to be determined “in a manner consistent with” in-person services, but does not mention that the payment needs to be the same.
e NH voted to expand Medicaid coverage to store and forward and remote patient monitoring, effective in 2020.
f Ohio recently passed HB 166 recently passed on 7/18/19, telemedicine services be reimbursed at the same rate as equivalent in-person services, for health benefit plans issues or renewed as of 2021.
g In statute, HI includes a patient’s home as eligible originating site, but not included in Administrative Rules.
SOURCE: Center for Connected Health Policy. Current State Laws & Reimbursement Policies. Updated Oct 15, 2019. 

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